Just as optimal integration of lab results into our patient work-ups makes ‘the invisible visible’ we thought we might make visible some of the everyday Q & A that we engage in with wonderful practitioners who are fast becoming Diagnostic Divas & Divos.
Practitioner: I am currently doing the MasterCourse I & loving it! I just want to clarify time-frames for change with respect to high liver enzymes e.g. male client has made awesome diet changes & lost about 10kg over 12 weeks but I’m slightly disappointed some of his markers are still high. You’ve said that most liver enzymes have a half-life between 2-10 days so, I guess it just takes more time to repair any damage/reduce fatty filtration of liver and ALT reducing by 10 is great and with the weight off and healthy eating it will continue to decrease?
Rachel: This is a great question you ask and one worth clarifying:
So the half-life of the LFTs is most meaningful with respect to a transient effect or artefact – raised GGT with drinking EtoH or raised AST/ ALT post strenuous exercise – this aids us in recognising the ‘window’ to allow for normalisation following a time-specific event/action or interference
But when raised levels reflect chronic change/pathology/or a pathophysiological process, at the very least – of course, it is no longer about how long that enzyme remains in the b/stream but about the time it takes to turn this unhealthy state of the liver around. I know you know this because you basically answered your own question🤓💪 I would say you are making GREAT progress with this patient not only by the reduction in ALT (and corresponding increase in De Ritis ratio) but also by the impressive drop in triglycerides and GGT!
The primary objective of MasterCourse I is to realise the true value we can extract from the most commonly performed labs (ELFTs, FBE, WCC, Lipids & Glucose) which constitute the largest biochemical dataset we have on almost every patient. By learning how to comprehensively interpret these labs in an integrated medical framework, using the very latest science, we can extract the gold often buried in this goldmine. Accordingly, we prove ourselves to be the greatest asset to our patients, to other health professionals we are sharing care of patients with and we cut the cost of additional expensive testing, that is less well understood and validated.
MasterCourse I will help you access that gold and has been intentionally designed to match each lesson with real learning– with the time spent in theory and in application. Delivered across 24+ hrs of streaming video sessions with bonus pre-sessions, audios, resources and tools – this MasterCourse is likely to be a genuine game-changer for the way you practise and the potency of your patient prescriptions.
6 sessions of online learning video presentations (total 24+hours)
Rachel provides you with questions, mini-assessments & lots of opportunities for case study application, testing your comprehension & understanding as you go.
Included BONUS preparatory videos: Patient Pathology Manager + Accurate Pathology Interpretation Starts Here!
Included BONUS audios, notes, desktop resources and templates you can use in your clinic with your own patients.
You get to keep all content in your online account forever and replay as often as you like.
There’s a bit of a backstory – play along at home if you want – by ticking off the steps in this journey we have travelled together! 😂
14 years ago I was first asked to contribute to ACNEM’s thyroid training module 9 years ago I put together a little Masterclass on Diagnostics & 6 years ago co-created another one on Thyroid 3 years ago I dived deep into new literature to update my ideas & my teaching for ACNEM again & was reinspired by all I had discovered 2 year ago I promised a new MasterCourse, for all those eagerly awaiting the next instalment: Thyroid & Adrenals Diagnostics and 6mo ago I delivered!! [phew…exhale] Today I am launching our Update in Under 30 Thyroid Collective for those of you that want more ready resources at your fingertips!
This is a curated retrospective collection of under 30mins (ok…mostly!) recordings & accompanying resources that cover a wide breadth of aspects that affect all of us working in thyroid health… btw… that’s everyone 😉 With individual episodes covering everything from patient presentations to lab interpretations and iatrogenic to metabolic drivers of thyroid dis-ease, from T3 hibernation to high-normal T3 as a response to adiposity & so much more in between!… that we’ve put it all in the one spot for ease and convenience as your go-to thyroid library.
The updated content covered across this collective puts a firm stop to all the lazy labelling around thyroid: ‘You have a bad thyroid – that’s why you…[can’t lose weight, feel tired, have SIBO etc]’ And misdirected management, especially a tendency to overload the butterfly with ‘thyroid’ nutrients – which can do more harm than good
‘When will she ever stop challenging us all to stay up to date with the research revolutionising our understanding of thyroid health & disease?’ I hear you say. ‘Never,’ she replied!!🌈❤️
UU30 The Thyroid Collective
Welcome to UU30 The Thyroid Collective!! Over more than a decade, Rachel’s work in thyroid health has gained an enormous following & an impressive reputation for its excellence in quality practitioner education. You may have up-skilled alongside Rachel, undertaking her substantial MasterCourse II in Thyroid & Adrenal Diagnostics or completed smaller instalments on an as-needed basis. Either way this collection of 10 Update in Under 30 episodes provides you with your very own library of thyroid resources & research summaries on a juicy selection of thyroid presentations, investigations and treatment approaches. These are not new episodes but a curated collection of those previously released which have been reviewed to ensure they stand up in the context of all the new research and we can officially declare them – ‘good to go and full of gold!’
Just as optimal integration of lab results into our patient work-ups makes ‘the invisible visible’ we thought we might make visible some of the everyday Q & A that we engage in with wonderful practitioners who are fast becoming Diagnostic Divas & Divos.
Practitioner : I thoroughly enjoyed taking a deep dive into your Mastercourse II Thyroid & Adrenal Diagnostics and have also tuned into your Update in Under 30 episode on Thyroid Nodules – thank you so much for consolidating the research and helping us to become better practitioners. I just have one question, if you wouldn’t mind. (more…)
Ever met a set of thyroid results you didn’t like? Because you couldn’t work them out? Because they defied your expectations, & therefore your understanding, of how they should look in this patient given their weight, nutrition, meds, diagnoses? Yeah – me too.
In simple terms this is because we are taught ‘perfect patterns’ in thyroid interpretation: * Iodine deficiency produces HN (high-normal) TSH and a shift towards T3 *Inflammation produces low TSH and T3 with a shift towards rT3 *Viral attack of the thyroid itself causes HN levels of both T4 & T3 due to spillage of preformed hormones, & secondary suppression of TSH
So can I ask: What about the patient who has a virus that is causing significant inflammation, attacking the gland directly but has a pre-existing Iodine deficiency? Seriously. What would you expect to see as the HPT responds to all of these concurrent disruptors?(more…)
Did you know that your thyroid expresses more ACE 2 receptors than your lungs? So while there is nothing new about the potential for a virus (or indeed even a vaccine against a virus) to impact thyroid form and function, the particular predilection this recent virus has demonstrated for this gland, and in turn, the wide spectrum of thyroid dysfunction and disease that has now been documented in response to this, is unparalleled and warrants our attention.
There’s a push to publish right now such that information and knowledge regarding anything and everything to do with the Covid 19 pandemic can be quickly shared.
While we need to balance this with the deeper appreciation that research that reflects the entirety of the story will take a lot longer to come to light – the data already in, speaking to this strong pathophysiological relationship between Covid 19 & thyroid health, is hard to look away from – especially when patients are already presenting with this chapter in their ‘thyroid health biography’.
That might sound like a patient who tells you their ‘thyroid was affected’ by the virus when they were really sick, but apparently is ‘ok’ now (but don’t feel it!), or someone post vaccination who has had some ‘funny results’. Or it might look like reactivation of a previously under control or quiescent Grave’s or Hashimoto’s disease, or, in fact, a new AITD diagnosis all together post 2020. There’s a lot of candidates & contenders for the ‘next NEXT wave’ in this pandemic – but even higher numbers of even more diverse thyroid issues is a strong one.
Once you learn about the about the interplay between thyroid anatomy and physiology, viruses generally (yes viruses are *BIG* news in many patient’s progression to thyroid pathology) and this virus, specifically, it becomes clear that we need to tune-in even more than before, to our patients’ potential for thyroid issues, as a contributor to why they’re seeking help for health concerns.
While there’s nothing new about the potential for viral driven thyroid disturbance, both acutely during infection and chronically following ‘recovery’, what is new and making news in the aftermath of the Covid 19 pandemic is the particular predilection this virus has shown for this gland. Thanks to its naturally high expression of ACE2 receptors (far more than seen in the lungs for example) the potential impacts, covering a wide spectrum of thyroid dysfunction & disease, have been observed and documented. This ranges from unprecedented rates of Euthyroid Sick Syndrome & Thyrotoxicosis during the acute phase to either activation (in an individual with a personal hx) or provocation (no previous hx or diagnosis) of autoimmune thyroid conditions as a result of either the infection or vaccination. Although there will be much more research to come that will help us clarify and confirm some of this detail, the data already in existence is undeniable and warrants our attention.
To purchase Thyroid Health in a Time of Covid, click here.
If I wrote down these 2 elements on a MindMap: Thyroid dysfunction and Adiposity, how would you connect them? Would you reflexively draw an arrow from the former to the latter to flag that the thyroid underpins the weight management issues? My arrow would be the other way around.
According to every scrap of data, the likelihood that someone’s subclinical or even frank hypothyroidism is the source of the excess weight is quite low, while the probability that their excess adiposity has had profound effects on both the anatomy of the gland and the physiology of the HPT is much higher.
And the change in the direction of this relationship – adiposity as the cause not the consequence – changes everything, from what we tell our patients, to what effective management, and success, in terms of follow-up TFT patterns, actually looks like. It’s far from semantics. Because while we may not encounter any cassava excesses in our practice, an established goitrogen with a long history, we do see unhealthy adiposity often and it is the ‘newest’ goitrogen on the block, so to speak.
The definition of a goitrogen is something that interferes with thyroid hormonogenesis and thyroid function in any way.
Abdominal adiposity, that is excessive for that individual, (I don’t believe this can be simply determined by BMI alone but requires us to apply a more sophisticated lens & metric) interferes in many many ways.
Aligned with this recognition is the seismic shift in understanding that we’ve undergone regarding ‘who or what’ is the boss of the thyroid. Hypothalamus & pituitary, I hear you say? Nope. These guys are just the middle managers – and the real bosses are a board of directors that includes adipose tissue. Stop and think about this – makes sense, right? The HPT is attributed with being the major endocrine axis that determines how much ‘energy’ we have to spend – so of course it’s taking direct messaging and direction from the adipocytes! Add to this, that excess energy consumption drives up TSH, a trophic agent for the gland – a stimulator of proliferation without differentiation and with no guarantee of an adequate supply of the greater requirements for micronutrients required to ‘grow a bigger gland’ without architectural or functional disturbance. These are just the 1st two stages of goitrogenic effect resulting from over-nutrition, that I refer to as The Over-Feed and The Under-Resourced Thyroid…
But what can follow are 2 more stages: ‘The Disturbed’ and finally, ‘The Diseased’ thyroid – which include pathophysiological processes such as adipocyte infiltration of the actual gland (akin to the liver infiltration in NAFLD) seronegative thyroiditis, as well as epigenetic changes impairing DNA correction etc etc all a consequence of weight gain…not the cause.
Thyroid dysfunction –> weight gain or Weight gain –> thyroid dysfunction…Time to rethink this relationship?
According to every scrap of research, the likelihood that someone’s subclinical or even frank hypothyroidism is the source of their excess weight is quite low, while the probability that their excess weight has had profound effects on both the anatomy of the gland and the physiology of the HPT is much higher. So rather than a reflexive assumption that someone who presents with weight gain or ongoing unhealthy weight should have their thyroid checked to see if that is the cause – the TFTs absolutely should be performed but instead to understand one of the key consequences of this excess adiposity. In this recording we highlight the 4 stages of impact, moving from: the ‘Overfed’ to the ‘Under-Resourced’, the ‘Disturbed’ and finally the ‘Diseased Thyroid’. The reversal of this relationship – adiposity as the cause not the consequence of thyroid dysfunction – changes everything, from what we tell our patients, to what effective management, and success, in terms of follow-up TFT patterns, actually looks like. We need to be alert and responsive to the most common and contemporary thyroid disruptor in our patients: fat is a goitrogen.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.
Over the years I’ve observed an increase in the incidence of practitioner paralysis. This occurs typically & understandably in the face of fearmongering. A good example is in the area of so-called ‘methylation medicine’ where we’ve been lead to believe that writing ‘the right’ nutritional prescription for patients requires a) their full gene profile, b) a knowledge of biochemistry that no one outside of a legit biochemist should have (!) and c) a bordering on perverse interest in in vitro research looking at how these pathways interact with different nutrients. And if we, as mere mortals (and naturopaths, nutritionists, herbalists or integrative pharmacists or GPs at that), are lacking in any of these WE WILL STUFF THIS UP GLOBALLY and put them on THE WRONG THING THAT WILL BE CATASROPH*C! Note: fearmongering always uses caps 😉
This stems from the misguided belief that ‘biochemistry alone maketh the man’ and ‘SNPs should write the ‘script!’
And the source of these falsisms are, what I refer to as, ‘Wallys with wall charts’. As impressed as we might be by individuals with brains for biochemistry or genetics, we should not let this overshadow the knowledge that health and disease are much more than 1 or 2 facets of your gene profile and how this may predict the pace of a few out of a million chemical reactions. Right? I mean I doubt any of us working in integrative health would intend to be so reductionistic and yet here we are with practitioners forgoing clinical (and RCT) evidence over that derived from in vitro with respect to supplements like SAMe and N-acetyl cystine, or worse still, taking as gospel, ideas that have come from pure hypotheses, based on 1 SNP out of an individual’s whole gene profile! This has infiltrated many areas of naturopathic and integrative medicine and certainly gotten the best of me at times too. But I am pushing back. Enough is enough. We humans are not our gene profile and holistic practitioners like us – know the manifold influences upon our health and wellbeing better than just about anyone else. And if you feel a bit lambasted by my little tirade – know that I have to give myself this very same talking- to every now and then – when I fall under the spell of Wallys and their wall charts!
In part one, we discovered the pro-drug nature of SAMe, revealing why evidence obtained from in vitro evidence can not be used to support either favourable claims or warnings. In the 2nd instalment we examined up close the misunderstandings about SAMe use in conjunction with antidepressants and clarified the real causes for concern in mental health clients. In this 3rd and final part we dissect claims and ideas about the success or safety of SAMe as a supplement with respect to methylation genetics and stages of pregnancy. All up this is indeed one BIG SAMe rethink that we reshape and re-inspire you about its prescription.
You know the saying, ‘If I had a dollar…’, well there’s so many ways I could finish that sentence, especially in relation to the most common questions I’m asked by praccies on a weeklybasis and ‘Can my patient on antidepressant ‘X’ take SAMe?’, would be in the top 10! While many of you might be mouths agape reading this, I bet the cause of that comical expression is not the same for everyone. Yes, like you, they’ve read the mandatory label warning: ‘individuals who are using prescription antidepressants or suffer from bipolar depression should not use this product unless under the supervision of a healthcare practitioner’ – but let me ask you, how do you interpret that? Turns out there are several interpretations and the most common is the most incorrect.
Yes you heard me. It’s time to remove that stain on SAMe’s reputation and take this nutraceutical, lauded amongst researchers and clinicians internationally for its excellent safety profile exactly in that scenario, in combination with antidepressants and other psych meds, out of the naughty corner – where it was mistakenly put in the first place! [No one puts SAMe in the corner 😂]
But I’m in no doubt many of you will take some convincing and while I am armed and dangerous ready with the answers, some will want to hear it from more than just me (and I 🙌 you ) Easy then – just read the research – take these for starters this one, that one, oh and this one – but there’s plenty more! Once you have, you’ll likely be scratching your head and asking yourself as I did, ‘How did we come to be so misinformed and come to a place where SAMe is so misunderstood?!’
I can answer that too 😉 And then for good measure I hope your brain pings you straight back to that warning on the SAMe label to follow up with – and what is the actual correct meaning and take-home of that label warning then?!🤔
In the previous Update in Under 30 episode we established where are lot of the misunderstanding originates with SAMe, in particular from lab based research that has little-no relevance on the effects of taking SAMe as a supplement, given what we understand now about its bioavailability and pharmacokinetics. While this helped us contextualise such ideas and get some serious perspective on the camp that exudes mild-moderate SAMe hysteria (arms flailing like the robot from Lost in Space, ‘Danger Will Robinson!”), supplemental SAMe is not right nor safe for all. And that is indeed something we need to sharpen our tools and our skills in recognising, monitoring and managing. Just a little somethin’ for your Christmas stocking & all those lazy hours on the beach you’re banking on over the break 😉
You’re welcome🤶
The Big SAMe Rethink Part 2
In part 1 we established where a lot of the misunderstanding originates with SAMe, in particular from lab-based research that has little-no relevance regarding the effects of taking SAMe as a supplement, given what we now understand about its behaviour in the body. In this instalment we go on to examine the evidence that led to the mistaken belief that SAMe was not safe in combination with pharmaceutical antidepressants and explore what the real safety concerns are with respect to its use in mental health patients. This audio comes with a great resource that helps you to both prescribe and supervise the taking of SAMe in your depressed patients, minimising risk and optimising outcomes.
Recently a very experienced practitioner who uses SAMe frequently and successfully in her patients and also delivers education said to me, “I don’t know what I am doing wrong – practitioners still come back to me with cases where they’re throwing 8 different products at a patient to ‘lower histamine, improve mental health and support methylation’ instead of using just one – SAMe!” I laughed and said, whatever you’re doing WRONG in trying to teach people about SAMe I am doing WRONGER and for LONGER!! I’ve been trying to encourage and inspire confidence in prescribing SAMe for 2 decades now and still some of my most loyal listeners, are like, ‘I still haven’t prescribed it, I am too scared.’ 🤯
But I think the fear factor around SAMe occurs for several reasons: Misinformation – there is a LOT of misinformation about HOW SAMe works and WHAT kind of power it wields therapeutically Misunderstanding – this comes from a couple of key misunderstandings about drug interactions and SAMe pharmacokinetics & pharmacodynamics Mystery – even for me, SAMe has had an air of mystery about it, nagging, seemingly unanswerable questions that can undermine our confidence and certainty about its appropriate use and safety
I get it. And given the studies employing SAMe as a therapeutic agent date all the way back to the 1970s and continue to today – in psychiatry, hepatobiliary disease, cancer etc – there is a LOT of information that has been gathered overall and a LOT of old ideas/theories/speculation replaced by understanding thanks to better methods and models of scientific enquiry. So I decided it was time for me to confront this ‘man/molecule/medicine of mystery’ head on, conduct a completely updated literature review of SAMe and along the way – challenge many of my long held beliefs.
I thought about calling this latest episode, ’30 Things You Don’t Know About SAMe’ – and calling it like a horse race because in all honesty I learned THAT MUCH!
But I settled for: The Big SAMe Rethink – inspired by one of many pivotal papers which helped to revolutionise my understanding & approach to this nutraceutical which you can read yourself here. Misinformation, misunderstandings and mystery be gone (ok well most of it anyway!) – by filling in the gaps in our information that previously fuelled these – we can move forward with much greater confidence and clarity and we now know where the real safety concerns exist.
The Big SAMe Rethink Part1 Do you feel like you need to pick a SAMe side? Researchers and clinicians, alike, seem divided in their opinion about its therapeutic capacity and certainly its safety. One side are the ‘naysayers’: ‘SAMe can’t possibly be effective for both depression and in hepatobiliary conditions and and and’. Keeping them company are the ‘doomsayers’, preaching danger and destruction should we prescribe this ‘universal methyl donor’. But the other camp can seem just as fanatical and far-fetched at times: ‘it’s good for just about everything with zero safety concerns’. The divide and differences come down to origins of evidence and, once again, the truth lay somewhere in the middle. This new information on SAMe’s behaviour as a supplement will prompt you to rethink so much of what you thought you knew, whatever side you’re on!
This is not about body shaming nor body positivity. I understand the crudeness of the body mass index, as a measure of (un)healthy weight – let alone (un)healthy muscle mass, so I don’t use this as a stand-alone assessment of weight, nor rigidly adhere to the categories it allocates individuals. With only minor recognised racial adjustments for BMI, I also recognise our concept of ‘healthy weight’ is incredibly whitewashed with minimal regard and consideration for clear ethnic and racial differences in physique. Patient’s lab results tell the real story. It’s in their results that we can discover someone is thin-on-the-outside-fat-on-the-inside (TOFI) or FOTI. These are patients whose BMI, WC,WHR, Body fat% etc identify them as obese – yet there is not a whisper of what I call ‘Adiposity Patterns’: no subclinical inflammation, no reduced glucose tolerance or actual IR, no raised transaminases that we expect to correlate with girth and the corresponding fatty infiltration of their liver. In this, as in so many other aspects of clinical practice, we are reminded to see each individual, individually.
AND if we adhered to this always, listening unfiltered to the whole health story and letting the labs speak, we would not miss those patients in whom unhealthy weight really is the most important underpinning, & all impacting, issue. And we are not doing our job, when we don’t.
I mean – we all know the detrimental effects of excessive adiposity – that’s like Pathology Unit 1 topic 1, right? I know we know it. Yet there are so many reasons why we might down-play, step-around, or even ignore its enormous contribution in our patient work-up and certainly the discussion that follows with our patients. That too is a no-brainer. Who wants to say to someone whose come seeking your help, as an explanation for their complex health concerns, ‘There’s no zebras here just a horse – one really over-weight horse!’ Knowing too that unhealthy weight results from the most complex constellation of factors (biopsychosocial) unique to each individual and that change in this health determinant, is arguably the slowest and hardest to sustain. But how are we serving our patients if we don’t?.
A practitioner presented this case of a 48yo F seeking help with the work-up: Self-reported inability to lose weight after 1st pregnancy = ‘obesity’ ongoing – now BMI 33.1 –> 25yo Reflux & Hiatus hernia Tx Omeprazole initiated – ongoing –> 26yo Depression Tx Venlafaxine initiated – ongoing –> 30s Back and other musculoskeletal injuries Tx Surgery & Opiates – ongoing –> 40s Hypertension & elevated resting HR –> Last 12mo – changes in Mx cycles suggestive of perimenopause & substantial weight gain
This patient didn’t ‘have’ any lab results but I think I can make an educated guess about how they would look and in particular whether they show the characteristic ‘adiposity patterns’ I mentioned before. What was my first thought about the most impactful element of the case? Obesity. What was my second thought? Where is all the weight (diet & intervention) history that would help us to understand how she is where she is, right now? We didn’t have any. The practitioner informed me that the patient was ‘not very interested in talking about her weight’ – in fact, according to her, it didn’t seem like losing weight was one of her goals. Now this could be several things: the fear of judgement, even her own self-loathing, the paralysing awareness of the enormity of such a goal, the dashed hopes of the past, or it could just be that her weight, as the key negative determinant of the majority of her health concerns & quality of life, has just never been brought to her attention, nor the connections explained to her in simple accessible language. So over to us, right?
There were other health determinants at play in this patient but the centrality of the adiposity was undeniable & the practitioner said this was the greatest take-home. She’d been ready to don some jungle gear and go hunting some zebras – but there was a horse right here in front of her and that could not and should not, ever be ignored.
What else became apparent was the lack of knowledge & skills regarding how to take a comprehensive weight history & why this is crucial. Not only for this type of unhealthy weight, the underweight require exquisite attention, as do those with a more labile weight than expected as an adult. This brilliant article by Kushner et al from 2020 is a total gift in that regard and a must-read for every clinician. We feel uncomfortable asking about certain things when a) a patient feels uncomfortable which is usually because b) we are uncomfortable and this ultimately comes from not being clear about WHY this information is so important and HOW this will ultimately enable us to better help THEM.
This is the very latest, comprehensive review of the key aspects of thyroid assessment that will revolutionise your understanding of thyroid markers. Gain a clear understanding of how to provide the best, most individualised, thyroid management by learning to read the real story in each patient’s pathology patterns. Boost your knowledge and confidence looking at TFTs, rT3, thyroid antibodies & related nutrient patterns, as well as AITD, environmental EDCs, HPA driven HPT issues, thyroid nodules, the impact of dietary macro- & micro-nutrient imbalances and much more!
This 4 part series provides over 10 hours of the very latest research & findings, punctuated with real case studies, that will both contemporise and deepen your understanding of all things thyroid, with a bonus recording on Adrenal Assessment.
And for weeks now I’ve really been banging 🥁🥁 The 1st drum was me making us all salivate & suffer through my month-long Mediterranean feast The 2nd, my ongoing incurable fixation on the ‘Power of the Ps’ – Protein & Potassium, not just individually, in terms of meeting optimal requirements for each, but relationally, as in, the (im)balance between them & the clear goals that have come from research for best health outcomes.
Maybe now you can hear the individual drumbeats merging to form some sort of chorus rather than a cacophony?! I can🎶 And largely that’s because I decided to put the Ps & Ps principles (Total Protein:Potassium < 1; Animal Protein:Potassium <0.6 etc) into practice, entering my own meals into software to see how often I kicked each goal and how often I missed (& [ouch] kicked myself). Personally, I think thirty years in the game can lead to some laziness around looking in depth at our own dietary habits. As in, I know the ‘rules’ right, back to front, so I’ve told the ref to have the rest of the season off! My meals are both mantra and memory foam. There’s a lot of eat and repeat. Like my heavy lunchtime reliance on my ‘protein power pack’: 2 XL soft boiled eggs on 1 piece of avocado paleo toast and a bunch of asparagus. My (in)famous buckwheat breakfasts loaded with nuts, yoghurt & fruit. My bulk-cooked plant protein heavy, animal protein light, stews, sauces and soups. Even, what I considered my laziest but luscious organic farmers market meal, pan fried lamb rump steak, steamed fresh new season potatoes & a bunch of asparagus. So which of these would you have put your money on for the most Ps& Ps goals kicked? 🤓🤯
The Lazy Luscious Steak & Veg Meal Wins with… Total Protein : Potassium of 0.56! Animal Protein : Potassium of 0.41 Btw that’s because of the Potassium-punch of Potatoes [>2200mg!] and the finale of Figs & dark chocolate [329mg]! Animal Protein : Vegetable Protein of 2 : 1 (ok so you can’t win everything!)
Now obviously I am just looking at each meal individually, but the Protein & Potassium goals are really daily ones, however, I, like most people, don’t lay out the totality of my ideal food intake for the day and then think, now how do I make this all edible?! I think in meals not metadata! So this little exercise was already incredibly rich in insights, checking my assumptions and snapping me out of some misguided mental calculations into the real world, placing a ref back on the pitch! I’m not ditching any of these favourites – just more mindful of what meal goes with others across the day, for better balance. Now all this analysis is time-consuming of course and while various software will do the macro and micro crunch, as far as I know, you still need to do all the Protein and Potassium calculations by hand, Ah yup. So, 1) I’m stopping now & 2) I’m thinking about creating a little spreadsheet that auto-calculates a lot of these targets once you’ve obtained that basic elemental data to input, for easier use in the future – would you use it?? [insert answer here 🙋♂️]
And then you can show me your kick arse protein/potassium combo! Because clearly even us ‘experts’ apparently need data to double-check our assumptions!
Now where’s the other 🥁 in all this, that Mediterranean one, I hear you ask? It’s in the figs! My lamb dinner actually just missed reaching the targets for protein and potassium balance…until my fig finale! And remember, what the Greeks say, ‘A few figs a day keep the chronic-mild-metabolic-acidosis at bay!’ 😂 Just jokes…
To prevent or minimise our slow but steady march towards sarcopenia, the need for dietary protein adequacy to fuel muscle maintenance is a no-brainer – but how does ageing affect this? We get less bang for our buck. We have to eat more, to get the same ‘amount’ but do you know why this is? Add to this, that also as we age, we experience a greater acid burden from a lower acid dietary load. And given that a higher acid load (PRAL), has been shown to have a negative effect on muscle and bone markers in the past, clearly to ensure optimal health of our bones and muscles as we age, we have a riddle, or two, we need to solve. How do we use Protein and Potassium intakes to benchmark our patient’s diet quality and musculoskeletal risks and can we modify their consumption of either, to drive therapeutic gains in terms of both BMD and muscle?
You can purchase The Protein & Potassium Riddle of Ageing – Muscles and Boneshere.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.
Ok look away now if you’ve already heard too much from me about Greece. I understand. For the rest of you, still prepared to tough-out the travel tales, we’ve been discussing my recent thrill at eating something very similar to the Mediterranean diet – often touted as the panacea of dietary principles by nutrition researchers worldwide. And then, I also confessed to some [ahem] deviations from this, and from what I would normally think would constitute a healthy diet for me. Lastly, I put out the question, “So how is it that with all these dietary demons I felt great?”
Just like me, some of your busy brains got busier! “It’s the holiday-factor aka lower cortisol!” “It’s all the incidental exercise you did at the same time!” “It’s the climate – you were basking in sunshine!” “It’s the different bread!!!”
Just like me, you were alert to the unmistakable fact that this was not a single variable intervention! All of the above, & more, had changed along with my food intake. I was on Ikaria for most of my month – which is a Blue Zone due to the locals remarkable longevity – above and beyond that of other Greeks and those living in the Mediterranean generally. While there, this conversation about the contributions to Ikarians’ health came up, again and again: ‘It’s our attitude – we just don’t stress about things” says the man who doesn’t open his little Taverna till 9 or 10pm each night because his ‘real job’ is looking after his goats & vegetables. So the locals, who all know where the key is, let themselves in and await his appearance. He cooks for his friends as a way to keep company and community not to make a living. “It’s our physical labour”, says another who splits her time between Ikaria and Sydney, “the 70 and 80 year olds aren’t sitting at home waiting for a visit, they are out in the fields, tending to their garden, mending their house etc” “It’s our unique thermal pools around the island at the edge of the ocean”, say many, “they’re rich in Radium & Thorium”
Hang on, back up there, I’m soaking twice a day every day, in what?!
Yes it is a well-researched phenomenon that the levels of radioactive elements in the oceanic geothermal springs of Ikaria exceed the amounts safe to consume. Luckily, I wasn’t ingesting it, outside of the occasional wave that caught my face off-guard. But this is not the end of the issue. Actually, the hot springs featured in my video above, where I stayed and bathed for a week, is referred to by locals as ‘immortal water’ and considered potable. While, I didn’t meet any such locals who made mention of drinking the stuff, several warned us against spending too long in the pools, but with the hottest temp recorded in Ikaria springs, also the hottest recorded anywhere in Greece, at 58.3 C, that may have just been because we were cooking our insides! While the science says dermal uptake of Radium is unlikely and volatilisation leading to inhaled vapour is also unlikely – I am still undecided about what role the unusual radioactivity of the place – also seen in the soil- plays in the health of the Ikarians – either good (longevity-wise) and bad (anecdotal reports of very high rates of thyroid issues – but this could be a very well-cooked red herring!). Listen I am the first with my hand up for hot springs, anywhere!! Case in point above. But this has left me with an open tab in my brain about the real health implications of the unique make-up of each.
So what is the Mediterranean diet’s most powerful mechanism-of-action (MoA)? Well if you’re doing it properly, you’re somewhere in the Mediterranean 💕😂
Notice a bit of a theme? Me too. Ok, so 50 is a landmark year, for lots of great reasons & they are all staring me right in my (increasingly wrinkled) face. But just at the edges of my now newly bespectacled visual field, I catch a glimpse of that stealth threat and thief: senescence! Consequently, for purely personal gain 😂, a couple of months ago I took a microscopic look at what happens to our ECM as we age, and [ahem] all you glib young folk, that starts at 18 😱😱😱 so wipe that smile off your incredibly elasticised and collagenised faces!!
Now my lens has zoomed out, to take a more macro view of what happens to our musculoskeletal system as we get older and the very latest research about what role these 2 key indicator nutrients (of dietary quality, of PRAL, of many key health outcomes) play.
For most of us, the need for dietary protein adequacy to fuel and fund muscle maintenance or growth is a no-brainer – but how does ageing affect this? We get less bang for our buck. We have to eat more, to get the same ‘amount’ but do you know why this is? Add to this, that also as we age, we experience a greater acid burden from a lower acidogenic dietary load. And this has been shown to have a negative effect on muscle and bone markers and well – we have a riddle (or…spoiler alert… 4) on our hands! This has been a hotly debated and controversial area of nutritional research – particularly with respect to the acid-ash hypothesis and especially with regard to how this influences bone dynamics, the risk and trajectory of, osteoporosis etc
But at last we have a very meticulousmeta-analysis & systematic reviewthat has clarified much – and certainly given both ‘sides’ (the ‘nay-sayers’, as in, acid base balance plays no part whatsoever in anything & the ‘PRAL preachers’, as in the end is nigh if the acid is high) some re-direction.
And then there’s the ever-growing recognition of the potent and pervasive impact of sarcopenia (yes I’m talking to ALL of us!) Together with a new heightened appreciation of how powerful a player nutrition is, especially Protein and Potassium, in setting the scene for healthy homeostasis and preventing decline. So take a read of these key articles yourself or join me in the latest Update in Under 30 Episode to get the low-down on how we can master the musculoskeletal ageing slowdown!
To prevent or minimise our slow but steady march towards sarcopenia, the need for dietary protein adequacy to fuel muscle maintenance is a no-brainer – but how does ageing affect this? We get less bang for our buck. We have to eat more, to get the same ‘amount’ but do you know why this is? Add to this, that also as we age, we experience a greater acid burden from a lower acid dietary load. And given that a higher acid load (PRAL), has been shown to have a negative effect on muscle and bone markers in the past, clearly to ensure optimal health of our bones and muscles as we age, we have a riddle, or two, we need to solve. How do we use Protein and Potassium intakes to benchmark our patient’s diet quality and musculoskeletal risks and can we modify their consumption of either, to drive therapeutic gains in terms of both BMD and muscle?
You can purchase The Protein & Potassium Riddle of Ageing – Muscles and Boneshere.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.
But just like so many well-meaning researchers who purport to employ ‘THE’ Mediterranean diet while their dietary intervention is actually just a rough approximation, I can’t claim that what I ate over my month in Greece was an identical replica of what the locals were munching on circa 1960.
The majority of meals absolutely ticked every tenet of what we’ve come to associate with this style of eating: 💪Dominated by Vegetables e.g. 9 serves a day
💪A few foraged Fruits e.g. 2 serves
💪Olive oil over everything!! e.g. up to 8 serves
💪Loaded with Legumes AND Grains e.g. up to 13 serves!!
But of course the ‘cereal’ serves in my month-long feast were primarily presented in the form of *BREAD*. Yep gluten-full, yeast-abundant typically white, bread! And rather than ‘our daily bread’ try…thrice daily bread 🤯 None of us being bread-eaters back home we tried to initially politely decline the *BASKET OF BREAD* that automatically arrived on every table. every time! This, in turn, was received by the waitstaff with either SHOCK or LAUGHTER😂 and often even a genuinely astounded, ‘Why not?!’ Ring any bells for anyone else? And to be honest, this was a question, we ended up asking ourselves. Because, while none of us would cope with that kind of bread burden in Australia – digestive and or energy-wise – we were right as rain wiping up all the oil and left over sauce off our plate with big pieces of the fluffy lovely stuff!
Add to this some other things I would never dream of back home: 🤯Adding sugar to my coffee – hey if you’ve tasted Greek coffee you’ll know this is non-negotiable!
🤯I’m a ‘grilled gal’ over fried but in Greece I became a fan of fried aubergine, zucchini you name it!
🤯Eating almost without pause – grazing*lazing*grazing – and not even extended overnight fasting which is my norm
🤯Executing a ‘seek and destroy’ policy on pastries like this…
So how is it that with all these dietary demons I felt great? Full of energy, no GIT issues, and while my clothes don’t fit like they did before my trip, it’s in the opposite direction of what you might suspect! But of course, the adoption of the Mediterranean diet AND these transgressions were not the only things that changed over my month…and just like speculation on other elements of lifestyle, which may convey the health benefits to the Mediterranean people, we might need to examine these as well…more to come…(again, if you can bear it!!!)
Somehow it didn’t dawn on me immediately, that I was in fact living this nutrition nerd’s dream…I WAS ACTUALLY EATING THE MEDITERRANEAN DIET! 🤯 😍 Like, the real-deal, legit, bona fide, honest-to-goodness, original, dinkum 1960s Greek diet.
That realisation occurred to me, I think, on the very remote island of Ikaria, not far from Turkey. After walking several kms from our already remote village to the next, we entered the tiniest of shops (and there was only 1), and slowly surveyed every single thing on offer to that community. Which prompted me to turn to my daughter and insist she immediately take a photo of the disproportionately large shelf-space dedicated to legumes! Ah yes…can’t travel with them…(nats/nuts/herbies you know who you are!)
Now of course, and I’ve acknowledged this before, in some regards I’m a bit slow. Because this fact was there from the outset for the taking – along with all the figs (fresh, dried & every stage between), pomegranates, grapes, blackberries, almonds, walnuts, prickly & wild pears, freely available, growing along most roadsides, footpaths, farmers tracks & parks, that we enjoyed collecting on any & every walk. With the bounty deposited straight into my open mouth, all my and my bag’s pockets and even my keep-cup, which proved a great way to protect delicate delicacies. With more time I even scaled-up, employing egg-cartons for mass-movement of figs, when making our teary but timely departure from the Dodecanese & return to Athens.
In this way, while consuming them in abundance every day, we were able to consistently cross ‘fruit and nuts’ off the list. Shopping done!
And perhaps it might have occurred to me after the 5th, 6th or 17th taverna meal, comprised essentially of all my favourite vegetables, absolutely swimming in olive oil, with a small bit of lamb, goat, fish, or seafood, tucked in there somewhere for good measure. Or given the meat’s exquisite flavours…’self-seasoned’ as my partner called it…tasting of the wild herbs & greens the animals themselves had eaten, all served with a side of beans – either fava, giant beans or lentils and oh my…we must discuss the bread… but next time.
I’m just getting started with tales from my feast field research trip…there’s so much more to tell (if you can bear it!!)
Gone are the days, thankfully, when we could all easily identify any individual taking an antipsychotic 1) because they were the marginalised ‘mad’ and 2) stigma and shame were rife. With the seismic shift that has occurred both in psychiatry & society we now know so many of the people we live or work with just might be taking ‘something’ & under any number of diagnostic labels. And increasingly the ‘anti-psychotics’ are not reserved for the psychotic nor the ‘mood stabilisers’ for the manic. Which can complicate things – especially when it comes to their thyroid.
You see it’s a mistake to think that only Lithium spells trouble for thyroid function
The latest piece of evidence from a study of over 25K BPAD patients in the US tells us this common misunderstanding makes us prone to not recognise all the other patients in whom their psych meds are disrupting and in fact driving thyroid (dys)function. Though Lithium carbonate remains the most noxious goitrogen due to its multiple disruptive mechanisms – the rest of a large group of Psych meds (yes even antidepressants!) are impacting to the point of effecting the thyroid function test results you are likely to see in patients taking these. And this is something we need to be alert to – these medications are essential, non-negotiable in most scenarios, but a secondary hypothyroidism is not their intended goal and can make matters worse.
Cue our growing understand of psychoneuroendocrinology, of course. Your HPT is influenced by your mood & vice versa
I told you I’ve rekindled my love and passion for thyroid pathology and this is one of the many elements I got to include in our latest updated training * Advanced Thyroid Assessment* and the upcoming MasterCourse. But I just had to hit record on this one aspect immediately – because if we don’t recognise the cause we are likely to be throwing all the wrong things at the thyroid – to no avail. This kind of subclinical or overt hypothyroidism is not due to nutrition per se, or due to some other kind of HPT re-setting influence like inflammation…it’s the meds & that necessitates different solutions & a much bigger conversation…so join me…
Many of us recognise the bidirectionality between thyroid function and psychiatry wherein ‘stress’ and mental illness can produce a predictable pattern and shift in TFTs and vice versa but regarding the question of psych meds as potential goitrogens, many of us are mistaken in thinking this issue begins and ends with the use of Lithium carbonate. As it turns out, an increasing number of these pharmaceuticals are recognised to disrupt thyroid health & activity via a variety of mechanisms both centrally and peripherally & as a result many patients may get stuck in a vicious loop of worsening thyroid function and mental wellbeing. – until someone calls it – someone like us.
How much? How often? When is the best time & timing? do you know about friends, foes and frenemies? Which form, when? e.g. building blocks or bioactives? And for how long? aka are we there yet…?
These are the kind of questions that one would imagine nutritional prescribers can always answer – but can you? Yet this is the goal, right? So that with each and every unique individual who needs supplements – we have a clear, consistent go-to framework to guide & direct these prescriptions. One that makes scientific sense, offers optimal outcomes and removes the uncertainty.
From my interactions with thousands of practitioners, however, I know many of these key questions plague practitioners & they feel, at times, as if they’re flying without a net, or without a strong systematic approach, or at the very least without all the answers to these questions.
I’ve had so much good fortune & so many others to thank for providing me with this foundation. Fay Paxton – my nutrition lecturer in my under-grad who indoctrinated me with a systematic approach. Dr. Tini Gruner – my principal supervisor at SCU, who shared & further fuelled my passion for biochemistry and reading labs to extract insights into each individual. And thanks also to all the pharmacists I’ve delivered education to over the years, who, as a result of their grounding in the principles of pharmacokinetics, always ask the best questions – questions that if I don’t know the answer I know I need to know the answer! So I made it my mission to find out!
While we dip into these aspects of nutritional prescribing in our regular mentoring groups on an ‘as needs’ basis, I’ve decided the time has come to create a year-long program dedicated to sharing this information and building this skill-set in practitioners.
This monthly meet-up is delivered live (max 1.5hr) and runs from Feb to November with the following currently proposed format *subject to change dependent upon the needs of the group
Feb Factors Affecting: digestion, absorption (host, form, dose)
March What happens to what gets left behind? e.g. enhanced enterocyte micronutrient concentrations & their effects plus unabsorbed nutrients & their interactions with the colonic environment
April What happens to what’s absorbed e.g. distribution, hierarchy of needs, activation and deactivation
May The pharmacokinetics of prescribing
June Where do our ideas on dosing come from? e.g. Physiological Vs Pharmacological dosing & actions. The basis & believability of maximal intake boundaries?
July Bioefficacy V Bioequivalence. Beyond building block nutrients: Is ‘Bio’ (-active, -peptides, -materials) always better? e.g. GABA Vs Glycine, NAC Vs GSH, PLP Vs Pyridoxine, Niacin Vs Niacinamide riboside ——————————————————————Aug month off—————————————————————————
Sept How often & for how long? Are we there yet? And how would we know? Plus Fast Vs Slow Nutritional therapeutics
Oct Strategies for Supplement Success e.g. friends, foes and frenemies in nutrition underpinning principles with examples; compliance changers for clients
Nov Live attendance & opportunity to participate in a case-based mentoring session
This monthly ‘live’ meet up will be delivered as part of 2023 Group Mentoring as The Nutritional Prescribing Program Group Mentoring applications open 17 October 2022.
To join the waiting list and be notified when applications are open, email the team at [email protected]
Find out more about what groups are available for Group Mentoring in 2023 here.
Have you been told somewhere by someone that the ‘perfect’ TSH is 1.5 mIU/L? This is a wonderful, terrible & wonderfully terrible example of ‘magical numbers medicine’. As a push-back against the published reference ranges we’re given, that are so wide you could drive a truck through them, there has been an over-correction by some, leading to the myth of ‘magic numbers’. We can narrow the reference range substantially for many parameters with good rationale, make no mistake about that but once we start setting ‘aspirational goals’ that are explicitly rigid…well we’ve done 2 things 1) forgotten about the patient to whom this result belongs and 2) disregarded viewing each result as part of a ‘pattern’, that we must piece together and make sense of.
Back to TSH then… if my obese patient had a value of 1.5 mIU/L this in fact would be woefully inadequate – so too a child at any weight.
And we expect a higher value as well in our elderly clients too and this level there may be, in fact, increased mortality.
But the same result would be excessively & worringly high in my patient who’s undergone thyroidectomy.
Realising the full value of any test result in terms of what it reveals about the person sitting in front of you, requires these more thinking and more thoughtfulness. Unfortunately, a list of ‘magic numbers’ will often lead you astray. And building your scientific knowledge about labs will not only help you avoid the pitfalls of pathology but will strengthen your pathophysiology prowess in surprising ways, saving your patients a packet in terms of additional extraneous testing and help you truly personalise your prescriptions…because the ‘invisible (biochemical individuality, oxidative stress, genetic probabilities, subclinical states, imbalanced or burdened processes etc) just became visible’. I started requesting lab results early in my career and years later was lucky enough to be taken under the wing of Dr. Tini Gruner. I found some of our shared notes, from 10 years ago, scribbled all over patient results recently and I was struck by just how lucky I was to have her encouragement to really pursue my interest and how she was a guiding force about learning to recognise pathology patterns over single parameters. A decade on I can concede, much of my clinical and educative success has come off the back of this foundational skill-set and I know, this is true for so many I’ve taught too.
“The guidance I’ve received over the years from Rachel in relation to pathology interpretation has been one of the most valuable (and fascinating) investments I’ve made as a clinician. Her teachings have filled gaps in my knowledge base I never knew needed filling and have significantly enhanced my understanding of the inner workings of the body! Rachel has an incredible ability to make the numbers that patient’s so often present us with, both understandable and clinically meaningful. The knowledge I’ve gained by investing in this skillset has paid off in dividends and I’m certain will continue to do so into the future.”
Stacey Curcio – Cultivating Wellness
I hope you’ll join me for the most exciting up-skilling opportunity in learning labs yet. Oh…and all this talk about thyroid testing..this next MasterCourse series is focused on revolutionising your understanding of thyroid, adrenal, HPT & HPA markers based on the very latest research & findings & marry these together with everything you learned in MasterCourse I (ELFTs, FBE, Lipids & Glucose) to understand the ‘whole story’.
…an absolute treasure trove of free integrative health information about your patient!
DEEP DIVE INTO REAL CASE STUDIES TO DEMONSTRATE EACH PATHOLOGY PATTERN IN ACTION. ]\
There are limited places. To sign up for Rachel’s LIVE Series – MasterCourse II: Thyroid & Adrenal Diagnostics and for more information click here.
One of my dear friends told her husband several years ago that she had noticed he was now making, ‘old man noises’ upon standing up from couches & chairs. She told him that must simply stop. She pointed out that he was only 50 and that she neither could nor would listen to that for another 40 years!
He stopped!
But aging and old (wo)man noises are coming for all of us, right? And by the time we’re making those noises or excusing ourselves from certain activities due to sore, dodgy or NQR [insert joint or body part], we’ve spent several decades unknowingly right on course to get here! We don’t generally pay any attention to our ECM (extracellular matrix) which suffers in silence, slowly but surely losing its structural & functional integrity from the age of 18 on, until we reach the tipping point: joint degeneration, repetitive soft tissue injuries etc, and a problem that will never be silent again! Cue your choice of anti-inflammatories it seems – til death do us part!
The Ageing Matrix is a thing.
And no I haven’t seen the movie – I don’t need to – I’m living it.
When I was pregnant I thought I wanted to specialise in pre-conception & pregnancy care. Then my babies arrived and I took a fancy to paediatrics. Sound familiar to anyone? Now, unsurprisingly, I have a real thirst for knowledge expressly aimed at bettering this whole ageing-thing! So in preparation for this Update in Under 30 episode, I’ve relished the opportunity to put the Ponds Institute & all similar cosmetic companies on notice! Scrutinising their claims that every woman on the planet would do better with more Collagen, more Elastin, more Hyaluronic Acid, just more of every key ECM component really. Ok, but in accordance with my bias and my business, my lit review pertained to oral supplements, not outrageously priced magical middle-life-crisis rubs and the therapeutic action I had in mind was the integrity of our ECM, and the roughly 2kg of collagen, we rely on, for functions a lot less frivolous than stopping sag. I have to say, I started out as non-believer but the research was quite the awakening…still there’s a lot to unpack here in order to repack our ECM and prevent against the erosion of its integrity and everything we build, and rely on, upon it – to live well!
Osteoarthritis (OA), like osteoporosis, is a diagnosis made after decades of disease. Underpinning it all, is our aging Extracellular Matrix (ECM) with its characteristic compositional change that leaves us vulnerable, from the ripe old age of 18! The ECM, like all other tissues, is made from basic building block nutrients but presented in their most fanciest of forms with triple helix structures, aggregates and other large molecular weight components, that each possess remarkable physico-chemical properties & convey extraordinary functionality to structures like joints. But is prevention against, and effective intervention for, OA as easy as consuming more of these ECM biomaterials?
You can purchase Supplementing Collagen & ECM Biomaterials – What’s the story?here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.
13 years ago I was first asked to contribute to ACNEM’s thyroid training 8 years ago I put together a little Masterclass on Diagnostics & 6 years ago co-created another one on Thyroid 2 years ago I dived deep into new literature to update my ideas & my teaching for ACNEM again & reinspired by all I had discovered 1 year ago I promised a new MasterCourse, for all those eagerly awaiting the next instalment: Thyroid & Adrenals Now it is about to land!
Across this time I have fallen in and out of love with this topic. ‘In’, in the early heady days of learning some great tricks and tools, ratios and relationships between thyroid parameters (T4:T3, rT3:T3 etc) to aid interpretation but then ‘out’, when I discovered in my own patients and many others, that while this solved some thyroid patient puzzles, it left the curlier ones with questions remaining. I became unsatisfied with the simplistic stereotyping of the thyroid hormones (T3 important & always good, T4 not, rT3 never) and frustrated by the misapplication of ratios & lazy labelling of the thyroid as the ‘problem’. All of these things I intrinsically knew didn’t make good scientific sense and actually revealed a lack of depth in mine & our understanding. So I re-immersed myself in the very latest research and, wouldn’t you know it, in the time between there’s been a mini-revolution taking place in relation to our understanding of the HPT axis and the other endocrine circuits that manage it! Thank goodness for science!!
As a result, not a slide, possibly barely a dot-point remains from what I wrote back in 2009 and not a great deal more from 2015 even.
That’s how far the research has revolutionised my ideas & understanding.
Some of the assay techniques & technologies are new, there’s a river of research & a mountain of meta-analyses published in the time between & I have had the privilege of innumerable more clinical encounters in this space, to really nut out how all this translates into the real world. And most importantly I can confidently say that this training and teaching reflects the truly integrative nature of psychoneuroimmunoendocrinology…did I just make up a word?! Basically, if you think that the hypothalamus and/or pituitary is the boss of the thyroid – we need to talk! There’s a lot I need to catch you up on.
So like our first MasterCourse in Comprehensive Diagnostics earned us a reputation for, we are going to leave no stone unturned – no difficult question – unanswered, like…
Can you list the critical roles in health of T4 that are independent of its precursor potential?
How about rT3 – what are the important health implications for us if we don’t have enough?
When shouldn’t the T4:T3 in the plasma be approximately 3:1?
When and why would a drop in TPO & Tg antibodies signal progression not remission of AITD?
In the absence of imaging, can you still be confident that thyroid nodules are the most likely differential in your patient?
What is the one test result that differentiates between Euthyroid Sick Syndrome and Central Hypothyroidism?
Exactly how low in Selenium, Iron or Zinc do you need to have a measurable impact on thyroid hormones and function?
Who escapes from the Wolff-Chaikoff effect and how long after iodine dosing can we be certain?
So stay tuned… and watch this space! We thank you for your patience and know it will be worth the wait…
“Absolutely loved this course, I’ve listened to each of the recordings at least 3 times now taking furious notes and am still picking up new gems. Love that it’s helping me build up my knowledge and confidence in such a fundamental area of practice. The case studies are super valuable as they bring the labs to life, I’d be keen for more of these! Really appreciate all the extra PDFs / audios that have been added also. Eagerly awaiting MasterCourse II” – Naturopath | Australia
“Why wasn’t this content covered in medical school? As a psychiatrist, I have greatly benefited from attending this course which comprehensively covers the ins and outs of interpretation of pathology labs and how this applies to clinical cases – many of which have both physical and mental health considerations. I believe all doctors from general practitioners to specialists will gain from attending! ” – Psychiatrist | Australia
“Thank you so much for this course, it has been brilliant. It has ‘fuelled my practice’ and many people have benefited already – from such insights. It’s quite thrilling!!! I’ll definitely be signing up for the second course later next year” – Naturopath, Medical Herbalist | New Zealand
You know the saying, ‘If I had a dollar…’, well there’s so many ways I could finish that sentence, especially in relation to the most common questions I’m asked by praccies on a weekly basis and ‘Can my patient on antidepressant ‘X’ take SAMe?’, would be in the top 10! While many of you might be mouths agape reading this, I bet the cause of that comical expression is not the same for everyone. Yes, like you, they’ve read the mandatory label warning: ‘individuals who are using prescription antidepressants or suffer from bipolar depression should not use this product unless under the supervision of a healthcare practitioner’ – but let me ask you, how do you interpret that? Turns out there are several interpretations and the most common is the most incorrect.
